NPIMap

Organization Active NPI

Physician Services of Ohio LLC

  • Psychiatry Physician
  • North Canton, OH
National Provider Identifier
1205053709
Registry record updated Jul 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
35081681 Issued in OH
Legal business name
PHYSICIAN SERVICES OF OHIO LLC
Practice address
2527 Macnaughten St NW
North Canton, OH 44720-9529
Phone
(330) 361-0908
Fax
(330) 305-6762
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Javedul Haque, MDNPI 1740253343
Title
Medical Director
Phone
(330) 361-0908

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 35081681 OH Primary

Addresses

Primary practice location

2527 Macnaughten St NW
North Canton, OH 44720-9529

Mailing address

2527 Macnaughten St NW
North Canton, OH 44720-9529
Phone (330) 361-0908

Other identifiers 1

IdentifierTypeStateIssuer
2527402MedicaidOH

National Provider Directory

National Provider Directory

Locations

4150 Belden Village St NW
Ste 600
Canton, OH 44718
Phone (330) 417-7533

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1205053709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2527 MACNAUGHTEN ST NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447209529",
            "telephone_number": "330-361-0908",
            "fax_number": "330-305-6762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2527 MACNAUGHTEN ST NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447209529",
            "telephone_number": "330-361-0908",
            "fax_number": "330-305-6762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES OF OHIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "HAQUE",
        "authorized_official_first_name": "JAVEDUL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "330-361-0908",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35081681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2527402",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.